| NPI | 1821167834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME115225) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 261189) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2022-03-14 |